Provider Demographics
NPI:1194202838
Name:KAMMAN PSYCHIATRIC LLC
Entity Type:Organization
Organization Name:KAMMAN PSYCHIATRIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEVORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMMAN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:860-858-1508
Mailing Address - Street 1:79 TRUMBULL ST STE C9
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-3708
Mailing Address - Country:US
Mailing Address - Phone:860-858-1508
Mailing Address - Fax:203-533-7395
Practice Address - Street 1:79 TRUMBULL ST STE C9
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3708
Practice Address - Country:US
Practice Address - Phone:860-858-1508
Practice Address - Fax:203-533-7395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty